Lenk

switzerland

I recently returned from a church Men’s Retreat in the resort town of Lenk, Switzerland. This was MY kind of ‘retreat.’ The majority of our two days was spent on the ski slopes, not talking about God and theology and right and wrong.

 

I’ve been a Christian since I was 8, so the pastoral lectures and Bible verses never feel especially new to me.

I routinely enjoy the music, and in our case a great band led those times in the evenings, but I was happy to attend a retreat that was mostly just a cheap ski vacation. I met some cool guys, got a little better on a snowboard, and stood in absolute awe at some of the most beautiful scenery I have ever known.

 

I don’t worship God very well through study, or through listening to lectures from pastors. Lectures, ever, haven’t worked well with my brain. Ask any teacher of mine all the way back to 1st grade and you’ll probably get some version of the same mildly exasperated half-smile, and a reply along the lines of, “he really, really TRIED to give a crap.”

 

Adelboden-Lenk

But when I’m in the shadow of the Swiss Alps, with 1,000 year old glaciers clinging to jagged sawtooth ridges in a 300-degree ring all around me, I pay attention. Somehow, breathing in crystal-pure air, with rolling forests and organic dairy farms dotting the countryside in every direction far below me, I have no problem thinking about God and wondering how I couldn’t possibly be closer to His almighty Spirit for that moment.

So, it was a spiritual time for me, but with very little preaching or Bible-studying. Perfect.

 

I was also struck by the unity and beauty of the towns we passed through on our way to Lenk. Switzerland has been highly resistant to change over the years, from what little I’ve read of the country. It is fairly hard to immigrate there, and once you ARE there, good luck building consensus around any particular idea or religious creed that departs from the time-honored ways of the Swiss. Du willst ein Minaret? Das wird nie passieren!

Deutsch: Chalet in Pöschenried, Gemeinde Lenk,...
These, dotting the countryside as far as you can see. Plus snow when it’s winter.

 

 

In Switzerland, you know you are in Switzerland. Especially in the countryside. The buildings are stirringly beautiful, most made of a light-colored wood sometimes set on dazzling white painted rock or concrete bases. The barns looks related to the houses. Everything is clean, ordered, pristine.

This unity isn’t by accident. But it takes enormous force of will to maintain a cultural identity in an increasingly pluralistic and mobile society. To do so inevitably becomes political, with increasingly volatile arguments on either side.

My homeland, America, has never really had a unity of culture and history to this degree. We’re a nation of very few subjugated natives, and very very many immigrants. To walk through my country – or any large American city – is to walk around the world.

Both have their merits (except for our treatment of the natives). But there’s something so deeply peaceful about meandering through a place that knows itself so well. A place that is OLD, and has not forgotten the value of of old things. King Solomon was rewarded by God with power and money because when God offered to give Solomon anything he wanted, the young man asked for wisdom. Any place that honors age, honors wisdom, and God seems to have blessed the Swiss accordingly.

I’m not saying Switzerland is paradise or utopia. There are problems. But they’re getting lots of things right. Here, walking is revered over driving. Food is valued for quality and purity rather than quick access or cost.The country has some of the best health care access in the world, with 3.6 doctors and 10.7 nurses per 1000 people. Life expectancy is around 73 years old. Obesity is less than 8% (it’s almost 50% in the U.S.), and it is estimated that 100% of the population has access to clean drinking water and sanitation facilities.

As a Caucasian from the American suburbs, with no knowledge of my heritage further back than my grandparents, this place holds an impossible appeal for me. I don’t know my family history, whether a story of thieves or kings. My nation’s history doesn’t even span 300 years.

As our retreat drew to a close, I knew I could never truly be a part of a place like Lenk, Switzerland. I could only marvel and yearn, watching that priceless world slip past my car window, as we hurried home.

 

‘Concierge’ Medicine – A De Facto Manifesto

My blogging output has been at an all-time low since moving to Europe.  Who knows why…this place is such a bore.  I continue to hack away at my book, which never seems to get close to done – the literary equivalent of Sisyphus’ ever-rolling stone.

The other day a reporter contacted me to hear my thoughts on so-called “concierge” medicine.  It was a timely query, since I’m considering a loose offer to join a concierge practice back in the States.  In my email reply to him, I found myself writing my own little manifesto on the subject.  A treatise, if you will.  A declaration.  A primer? A resolution, a promulgation…

William Osler (1849 - 1919), Professor of Clin...
I have a idea...how 'bout I actually know who you are, AND care about your medical issues?

 

I’m a big believer in concierge medical practice, although I use the term “concierge” only as a nod to already-established norms.  Really ‘concierge’ medicine is a throw-back to true primary care medicine before it was ruled by other industries.  So the idea isn’t new.  It’s old – old as William Osler and Johns Hopkins and William Carlos Williams.
This industrial “take-over” I mention isn’t entirely due to craven insurance businessmen.  It’s also due to the allure of “Wal-Mart” pricing that so captivates Americans.  I suppose you’ve heard the adage that as a consumer, you can only have 2 out of 3 options in the market: Fast, Good and Cheap.  If you want something fast (hamburger), you can get it cheap (McDonald’s) but it won’t be good.  Or, you can have it fast and “good” (quality, taste, etc), but it won’t be cheap (maybe, Red Robin?).
This principle is true in medicine too.  Americans, over the past 20 years, have been trending toward Fast and Cheap medicine, just like they want clothes, household goods, food, etc. quickly and cheaply.  Hence, the rise of WalMart, which provides easily acquired things of questionable quality.
Concierge medicine isn’t “cheap,” by WalMart standards.  It requires real cash investment.  But it IS better.  And, while there is little problem with wearing nondescript, zero-style golf shirts to work every day, primary care is different.  We’re talking about your life, here.  Not only are you likely to live longer and healthier with good primary care, but it really is cheaper over time because it is so effective in offsetting gigantic medical calamities later.
I dispute the notion that no one can afford concierge medicine, by the way.  Most people in the richest nation on earth perceive they can’t afford it, but really can.  I blame this perception on the invention of the 10-dollar co-pay.  This idea was such poison in American medicine.  It made medical care seem like the equivalent of a few iTunes, or sunglasses from a roadside gas station – just another in the ocean of cheap, disposable and generally worthless products. Yet so many Americans shell out enormous amounts of money on alcohol, cigarettes and fast food.  They don’t think twice about coming up with over a thousand dollars to fix the clutch on their car, or to trick it out with lights and racing wheels.  But when it comes to good, relationship-based primary care, they resent anything more than “10 bucks.”
I’m currently in a line of work that provides “free” care to everyone (the military), so at the moment I have no vested interest in the above comments.  But I continue to feel strongly that it is not immoral to require a reasonable, even significant, amount of money for true primary care, especially when obtaining that care may require cutting out things that are terrible for your health.  I see major problems with a medical system that tries to provide unlimited access, especially when coupled with zero perceived cost for that access and care.
More health care is not better health care; worse, it can be dangerous.  On a daily basis, people needlessly lose breasts, prostates (read: sex life), resistance to microbes, and countless other quality of life measures in the process of hunting down phantom maladies or responding to false-positive tests.  High-quality primary care offers good, analytically based work ups of genuine symptoms that justify that work up.  NOT investigating something further can often be the best medical care available.
I mention ‘analytically based’ decisions because most mid-levels (a cost-cutting invention in American medicine) are trained to provide algorithmic decision-making:  that is, if X symptom, then Y action with little analysis involved.  recipe medicine.
Often algorithmic medical decision-making is just fine, but it easily leads to over-testing and over-treatment.  When it comes to possibly dying from cancer, for example, most of us want someone who knows us, knows how we communicate, and what is important to us (e.g. dignity vs. “full court press”). Further, we want that same person to be well-trained in weighing the risks vs. the benefits of treatment vs. non-treatment, based on the latest available medical knowledge.
Doctors seeing 20 patients a day can’t provide this adequately.  Mid-levels are not trained to provide this type of risk-benefit analysis, and don’t have the hours of training experience even if they wanted to.
Disclaimer:  I’m speaking in generalities here; there are fantastic PA’s and NP’s out there, many of whom are compassionate and professional; better than many physicians.  Most I’ve met are smarter than me.  But in general, the care from a mid-level is fundamentally of less quality because the training of a doctor is an average of 3 times more than any mid-level (roughly 3,000 hrs vs. 12,000).  This differential limits mid-levels to algorithmic, rather than analytical, decision-making.  When it comes to your health care, the mantra should be “reason, not recipes.”
These days, you can’t get this care from HMO’s (Group Health in Seattle is getting very close), you can’t get it from mid-levels.  The only place I know where you can get this level of care, is in a ‘concierge’ practice, where the benefits of the increased cost are immeasurable.

Interview with A Virus

SW101: I’m sitting here today with Herpes Simplex Virus, type 2.  It has agreed to answer a few questions for SW101 Nation.  Thanks for joining us today, um, is it…Mr. Simplex?

HSV: “Mr.” Simplex.  Sure.  I’ll go with that.  (rolls eyes, muttering “humans”).

SW101:  Tell me, what do you regard as some of your greatest accomplishments, to date?

Mr. Simplex: We’re awesome, basically.  We like to consider ourselves ubiquitous, yet cosmopolitan.  We are particularly fond of the human idea of “make love, not war.”  mmMM.  Huge for us, that one.

SW101:  Ubiquitous?

Transmission electron micrograph of herpes sim...
Self-Portrait: Mr. Herpes

 

Mr. Simplex:  You got an ulcer on your nether-parts after a groovy night wearing nothing but beer goggles?  Probably us.  Any version of sexually active with any version of human being (we don’t like animals)?  Excellantae!  30% chance we’ll be right there with you.  Me and my posse are hanging out with 30-45 MILLION Americans.  And that just in the, ah, “middle” parts of the human landscape.  We got some cousins who live in the windy North quite happily.  We cross paths from time to time.

SW101:  Wow.  Qute a party.

Simplex: Yep.  And we’re inviting picking up around 300,000 new groupies every year.

SW101:  How’s that?

Simp:  We’re launching out all over the atmosphere much more often than people realize.  Those blistery sores we cause?  Well call ’em “pleasure domes,” referring to what they do for us as well as how our gracious hosts acquired them in the first place.  Anyway, we don’t just blast out from the popping penile blisters.  Usually, we send out early drones before the sore even forms.  We’re terribly proud of this tactic.

SW101:  Soo, when does the ‘party’ end?

Simplex:  That’s the best part.  Pretty much never.

SW101:  Like, never?

Simplex:  Oh sure, we take a break sometimes.  Lots of times, actually.  We hide most of the time.  But once we’re in a body, we don’t really ever leave.

SW101:  What do you hide from?

Simp:  There’s two things we don’t like in this world, and the Great White Army is the main one.

SW101:  Um, you refer to Tsar Ivan III‘s anti-Bolshevik Imperial Russian Army in the 1920’s?

Electron microscopic image of a single human l...
Human Lymphocyte. Non-friend to HSV's everywhere (everywhere it thinks to look, that is)

 

Simp:  What?!  What kind of freak-show wonk are you?  No!  The human immune system.  All the cells in that army are white.  Or clear.  Or something.  Scary, those guys.  They can blow us up, eat us, chew us up, spit out pieces of us so their comrades can eat the rest of us…it’s disgusting, really.  It’s like a bad horror movie.  Ugh!  Look at that picture of the immune cell!  Don’t you have any shame?  I didn’t walk in here holding up pictures of car accidents, or guys who accidentally fell into meat grinders, did I?  Why don’t we just sit around and ponder Charles Manson, and all his fabulous exploits?  Oh, actually, that guy was pretty good for us, as I recall.

Anyway, where was I?  (fans self, leans back weakly).  Oh yes, when it’s up and running full-bore, the human immune system it a giant headache for us.  We try to lay low.  No sense in getting our heads knocked off.  The good news is that it gets stretched pretty thin trying to cover all the problems that come up in those unnecessarily complex organisms of yours.  It’s pretty easy to come out and play once the person is stressed, sick, too hot or cold or with some disease that naturally keeps the White Army back in the barracks, so to speak.

SW101:  So, you hide in the nerves, right?

Mr. Simplex:  (looks left and right conspiratorially) Yep.  Broadly speaking.  This is the secret to our survival, by the way.  Our lair.  Your nerves.

SW101:  And, specifically?

Simplex:  Well, you guys have no hope of actually finding us, so I’ll just go ahead and tell you.  My guys hang out in the roots of the nerves that extend from the sacrum.  S2-5, usually.  In the ganglion.  It’s nice there.  Our version of what you’d call waterfront property, I’d imagine.  Our cousins hang out in similar nerves in the face.

SW101:  You mentioned two things you don’t like, what’s the other?

Simplex:  Condoms.  We hate ’em.

SW101:  That bad, huh?  Your great nemesis?

Simplex:  Well, actually, our relationship to them is a bit complicated.  Maybe like Ariel Sharon vs. Yassir Arafat.

SW101:  Surely you’re referring to the Israeli-Palestinian former leaders…both dead now?

Yasser Arafat at 'From Peacemaking to Peacebui...
Ariel Sharon thinks I'm a punk. I told him the feeling was mutual over tea this afternoon.

 

Simplex:  Dead?  Really?  I don’t think we had anything to do with that.  We try not to kill our hosts…bad for real estate, as you can imagine.  But yeah, them.  They hated each other, but at the same time, they created lots of business for each other too.  Get it?  People don’t like using condoms, for some reason.  But those that do are WAY lax about concerning themselves with us.  Since we don’t just hang out in areas covered by those suffocating, smothering latex udders, we get around pretty well when condoms are in the mix.  People jump into their illicit affairs, thinking they’re safe…and forget to ask anything about us.

So, it’s a love-hate thing.  Overall, condoms are probably pretty good for business.

SW101: So, you hate condoms.  What do you love?

Simples:  Promiscuity.  We’re BFF’s.  Make love, not war, dude.  Preferably, don’t even look down at what you’re doing.

It’s not personal, by the way.  We’re just doing what we are meant to do…which is reproduce.  Everyone who is living with us now should understand that.  It’s one big happy family of organisms doing what they were meant to do…mate, and reproduce.  It’s natural.  When you’re mating…so are we.  All I can say is, sorry for the inconvenience.